I'm currently working in a LTC facility in the Subacute/Rehab unit. I've been there 4 months. When I hired on, they said when the census hit 24, there would be 2 nurses on.
Well, we're at 29. We have 30 beds. I have 21 diabetics, almost all with sliding scale insulins to treat. And...I have to be in the dining room when the trays arrive (requirement by state).
I am finding it IMPOSSIBLE, as are my coworkers, to get there on time. I have dementia patients (apparently they just want to fill beds and don't care if it's a subacute unit), and they wander...so finding half of them to get their fingerstick done is also a chore.
I'm running to the point of sweat pouring off my body. I don't mind being busy; in fact I love the challenge and love running. But...I don't like being overwhelmed. I don't like running so hard and still not managing to get the tasks done on time. And it's not just me, the other nurses have expressed this to our unit manager, who is going to bat for us at some point this week.
The bottom line is: money. They have a marketing liason who gets these people recruited from discharge planners at the hospital with NO medical background. She waltzes in and states "You have 2 new admissions coming this shift." and smiles, heels clicking, walking down the hallway. She has no idea how difficult it is to get our work done, plus do quick head to toe assessments, get orders verified, get meds ordered, on top of the workload we already have.
The nursing home administrator has a background in business. She apparently "went to nursing school but didn't do clinicals." She has NEVER taken the time to assess what happens on our unit. She says, "Halls A and B have 30 patients and they have only one nurse." But....these people are long term care patients. I've worked those units, and the staff anticipate their needs (as they are demented and don't use their call lights). So, even though there are 30, there are only 2 diabetics, and they are not alert and oriented. They also only have about one or two patients that request PRN drugs.
My unit is diabetic and PRN hell. I can offer a PRN drug to a patient while I give them their scheduled meds, and they'll say "No. I don't need it now." (Which is fine). But then in the middle of getting 21 fingersticks, I'll have a patient ask for a suppository. Then an enema. Then 1/2 a vicodin. Then ask for me to come in and "remove my impaction". Then the phone ringing nonstop. Families of all of these patients calling asking how their aunt is. Families who are there who are demanding a cup of ice ...NOW.
I love what I do. And none of the nurses are willing to stick their heads out and make a stand. Corporate walks through and grabs the Vanco I.V. off my med cart as I am getting ready to walk into that patient's room. He has it in his hands and says, "Why is this here? Should I take it?" I reply, "If you have an infection and think you need it." He says, "Perhaps I'll report it to your D.O.N.". ****This is frustrating beyond all frustrating***** These Corporate Carls (I call them), come in, intimidate (or try to), and don't listen to the real issues. Don't understand that I'm going to put the I.V. Vanco on my cart as opposed to walk all the way back to the med room, if I'm getting ready to walk into the patient's room. There's no where to put it in my med cart.
The last Corporate Carl that walked in asked, "why isn't there a sign that says 'Med Room' on this door?". I about died. How about we advertise, in neon lights, "Narcs Found Here!!". I politely looked at him, ignoring his (what I felt to be ridiculous question), and said, "While you are here, would it be possible to assess the need for additional nursing staff?" He said, "You can ask me anything. It doesn't mean it will be honored." (while laughing).
It is a "for profit" organization. Is this the problem? Or is it the same everywhere, for all of us nurses? Have I seriously got a chance at getting someone somewhere to listen to our plea for help? Can I call the state? Is there a staff/patient ratio requirement on a LTC subacute unit? How do I find out?
I don't want to quit this job. I love what I do, but it has to be made POSSIBLE to get the work done safely for patients, and safely for our licenses.
Nurses are literally clocking out and going back to do their charting (No overtime allowed) to cover their butts. It seems that they will open up amongst each other, but have fear to make a stand. Maybe they know it will do no good.
I'm told by one of the attendings who comes in, "Nurses last about 3 months and then fly." I'm also aware that it's cheaper to have high turnover in staff than to retain staff and pay out benefits.
I'm feeling very unappreciated. Errors are unavoidable with the high demand on this unit. A missed med here, a missed treatment there....I see it everyday.
None of us want to quit....we just want to be able to work safely.
Any suggestions? I'm running out of hope....
Thank you.
Emma
Valerie Salva, BSN, RN
1,793 Posts
We are the ones paying, with our taxes, on Medicare units. The pts are risking their health and the nurses are risking their licensure- all the while, the corporations make money.
Taxpayers should be insisting on mandated ratios in Medicare units. It is ironic that Medicare rehab units are some of the most highly regulated entities in the US, yet there are no regs where it matters most: nurse to pt ratios.